Ohio Medicaid Waiver Providers and home care agencies are well aware of a new federally mandated law that will require all state Medicaid programs to implement new procedures for the consumers they serve. The new regulation requires Electronic Visit Verification (EVV) for home health and personal care services when delivered to Medicaid beneficiaries. The EVV mandate is from the 21st Century CURES Act which became law in December 2016.

The inclusion of an Electronic Visit Verification (EVV) requirement as part of the CURES act was specifically designed to reduce fraud, waste and abuse in the Medicaid system. States that do not comply with this EVV requirement by specific deadlines will see their Federal Medicaid Assistance Percentage (FMAP) rates reduced for each year that the state is out of compliance after the mandated implementation date. In order to encourage implementation, every state is given flexibility in designing their EVV system and can implement EVV before the mandated date.

What is the Federal Medicaid Assistance Percentage (FMAP)? This percentage is usually determined every year for each U.S. state and territory. The FMAP formula is designed so that the federal government pays a larger portion of Medicaid costs in states with lower per capita incomes relative to the national average. Inversely, states with a higher per capita income receive a smaller portion from the federal government. FMAP rates have a statutory minimum of 50% and a statutory maximum of 83%. For 2019, regular FMAP rates range from 50.00% to 76.39%. These FMAP rates are used to reimburse states for the federal share of most Medicaid expenditures, but exceptions to the regular FMAP rate have been made for certain states, situations, populations, providers, and services.

What are the specifics of EVV? Again, EVV is short for electronic visit verification. New federal regulations require verification of the actions taken by Medicaid consumers and their DSPs. All U.S. states are required to have EVV systems that verify the following six pieces of data for each personal care and/or home health service:

  1. type of service
  2. the person receiving the service
  3. date of service
  4. location of service
  5. the provider’s name
  6. time service begins and ends

EVV usage is required for home care agency employees and independent providers delivering specified Medicaid-funded services. There are three methods available for waiver providers in order to verify consumer visits.

  • EVV (electronic visit verification) – A device is mailed to the person’s home and all providers log in at the start and end of every visit. This is the primary method expected for the state of Ohio.
  • TVV (telephone visit verification)– The provider may use a landline or cell phone to call in and report the required information
  • MVV (manual visit verification)– The provider may log into a website and enter all required information for each visit.

The Ohio Department of Medicaid (ODM) is contracting with Sandata to design and run Ohio’s EVV system. The selected system utilizes mobile devices with GPS capability that are supplied to each Medicaid beneficiary receiving home health or personal care services. ODM is providing the Sandata EVV system at no cost to providers or individuals receiving DODD Waiver services. While the devices are assigned to a specific beneficiary, EVV is the responsibility of the agency providing a service, not the beneficiary receiving a service.

Direct Support Professionals (DSP) can also use a Sandata EVV application that can be installed on any mobile device that can be used instead of the supplied device. Each agency using the ODM system will have access to Sandata’s online portal where they can monitor and update their agency’s use of EVV. Ohio’s Department of Medicaid is implementing an “Open Model” approach for Electronic Visit Verification. This means that DODD providers and home care agencies can individually choose the best software provider that fits their needs.

However, all billing data (claims) will funnel through a Sandata aggregator system that will apply standardized business rules in order to ensure visits are properly verified and paid. Sandata will also provide comprehensive oversight to the entire EVV program. Agencies and independent providers can choose to use the Sandata system or a certified alternative EVV system. However, the alternative EVV systems must comply with all technical specifications and business rules and complete a certification process with Sandata before going into production.

Neither ODM or Sandata are responsible for any costs related to the development, certification or use of an alternate EVV system. If agencies or providers do not wish to use the system provided by the state of Ohio, they may use an alternate EVV system. But this alternate system must be approved by the Ohio Department of Medicaid. Consumer visits logged with EVV data that does not match the billing claims sent to ODM will eventually be denied.

When is the EVV mandate?

The law mandates that every state must have a state-wide EVV system operating by January 1, 2019, and for Medicaid-funded home health services and January 1, 2021, for Medicaid-funded personal care services. Each state is given flexibility in designing their EVV system and can implement EVV before the mandated dates. Over the last few months, some of the dates for EVV implementation have changed in Ohio. However, there are still three overall phases of EVV implementation.

Phase One: Limited to state plan home health nursing and aide services, private duty nursing, RN assessment, and Ohio Home Care Waiver nursing, aide and home care attendant services. ODM began collecting EVV data on January 8, 2018. All phase 1 visits were required to be documented using EVV for dates of service on and after July 8, 2018. Edits matching claims data to visit data using the units of service delivered and billed were implemented for dates of service on and after August 15, 2018. Those edits will begin to deny claims for dates of service on and after February 13, 2019.

Phase Two: Includes nursing, aide and home care attendant services provided through PASSPORT, IO waiver nursing and homemaker personal care (including services provided on behalf of individuals) provided through DODD waivers and nursing, aide and home care attendant services reimbursed through Medicaid managed care plans. In addition, group visits are being rolled into EVV across all phase 1 and phase 2 services. Mandatory data collection for phase 2 services will begin on August 5, 2019 and claims edits are expected to deny claims several months later. Self-directed services and services reimbursed through a daily billing rate are excluded from Phase 2.

Phase Three: Includes self-directed services and other services necessary to meet the requirements of the Cures Act. Mandatory data collection is tentatively scheduled for late spring or early summer in 2020.

Ohio EVV Updates:

June 2018 — Services administered by the Ohio Department of Developmental Disabilities (DODD) subject to Phase Two EVV implementation include nursing, delegated nursing, and 15-minute unit-based homemaker/personal care services. This does NOT include homemaker/personal care billed under the daily rate.

July 2018: House Resolution 6042 passed out of the United States Senate and was signed by President Trump. On the national level, the EVV implementation date is moved back to January 1, 2020**. The Centers for Medicare and Medicaid Services (CMS) has also begun taking ‘Good Faith Efforts’ applications from states to delay reductions in reimbursement by an additional year.

August 2018: The Ohio Department of Medicaid (ODM) issued a response to the passage of H.R. 6042. At this time, the Ohio Department of Medicaid is not planning on pushing back their stated timeline for Phase Two implementation in the state of Ohio. Training will be available at the beginning of 2019 and system “go live” will be on May 6th, 2019. Medicaid will begin to deny claims that do not have appropriate EVV visits in fall of 2019.

October 2018: ODM announced that Phase 2 of EVV implementation will be delayed to no later than August 5th, 2019. After this date, claims will begin to be denied if a DODD provider’s electronic visits and billing documentation does not match.

Medicaid Waiver providers are closely watching for updates from the Ohio Department of Medicaid. At eWebSchedule, we will also closely monitor ODM for any updates on the EVV implementation in the state of Ohio.

As an Ohio-based company, eWebSchedule delivers workforce management tools and services that are uniquely designed for human service agencies with direct support professionals. Our custom-built software applications were created specifically for the unique billing and scheduling needs of HCBS Medicaid Waiver providers. Whether your agency offers adult-day array, non-medical transport, ICF/DD (group homes), supported living or institutional respite – we can help. Contact us today.

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Electronic Visit Verification, EVV, Ohio Department of Medicaid